Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits

Abstract

BACKGROUND AND OBJECTIVES: Use of commercial direct-to-consumer (DTC) telemedicine outside of the pediatric medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC telemedicine visits. Our objective was to compare the quality of antibiotic prescribing for ARIs among children across 3 settings: DTC telemedicine, urgent care, and the primary care provider (PCP) office. METHODS:In a retrospective cohort study using 2015-2016 claims data from a large national commercial health plan, we identified ARI visits by children (0-17 years old), excluding visits with comorbidities that could affect antibiotic decisions. Visits were matched on age, sex, chronic medical complexity, state, rurality, health plan type, and ARI diagnosis category. Within the matched sample, we compared the percentage of ARI visits with any antibiotic prescribing and the percentage of ARI visits with guideline-concordant antibiotic management.RESULTS: There were 4604 DTC telemedicine, 38 408 urgent care, and 485 201 PCP visits for ARIs in the matched sample. Antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52% of DTC telemedicine visits versus 42% urgent care and 31% PCP visits; P , .001 for both comparisons). Guideline-concordant antibiotic management was lower at DTC telemedicine visits than at other settings (59% of DTC telemedicine visits versus 67% urgent care and 78% PCP visits; P , .001 for both comparisons).CONCLUSIONS: At DTC telemedicine visits, children with ARIs were more likely to receive antibiotics and less likely to receive guideline-concordant antibiotic management compared to children at PCP visits and urgent care visits.WHAT'S KNOWN ON THIS SUBJECT: Authors of previous studies identified concerns about antibiotic prescribing for adults using direct-to-consumer (DTC) telemedicine. No study has examined antibiotic prescribing during pediatric DTC telemedicine visits.WHAT THIS STUDY ADDS: Compared with urgent care and primary care visits, children receiving care for acute respiratory infections during DTC telemedicine visits are more likely to receive antibiotics and less likely to receive guideline-concordant antibiotic management.

Knowledge and practices regarding antibiotics use

“…Evidence from a previous retrospective cohort study comparing the quality of antibiotic prescribing for acute RTIs among children across three settings, demonstrated that receiving a guideline-concordant antibiotic prescription was less likely at telemedicine visits compared with matched visits at other clinical settings (i.e. urgent care, GP) [ 34 ].…”

<p>Pediatric Antimicrobial Stewardship Programs: Current Perspectives</p>

“…A retrospective analysis by Ray et al of 4600 pediatric telemedicine visits for acute respiratory tract infections found that children at telemedicine visits were more likely to receive antibiotics and less likely to receive antibiotic management concordant with pediatricspecific national guidelines compared to children seen by their primary care providers and by urgent care providers. 101 The authors of that study also emphasize the need for AS initiatives targeting direct-to-consumer telemedicine services.…”

Pediatrician, watch out for corona-phobia

“…Telemedicine has not been thoroughly assessed in pediatric care. Some studies conducted in pediatric telemedicine show an increased rate of antibiotic treatment and care recommendations inconsistent with up to date guidelines [18]. Studies conducted in adult patients similarly show a higher incidence of inappropriate pharmacological treatment [19], a guideline adherence rate of less than 60% and even the provision of a wrong diagnosis or no diagnosis at all in more than 23% of cases [20].…”